Expert Video Series: All About Sepsis
In this video, Dr. Lee Kiser of Columbus Regional Health explains how sepsis occurs in the body, what to watch for with infections, how to prevent sepsis and more.
I'm Dr. Kiser, and I currently work as a hospitalist and a nephrologist here at Columbus Regional Health. Today, I'm going to be talking about sepsis.
What Is Sepsis?
Sepsis is a disorder that occurs when your body has an abnormal response to infection, and your body typically has several lines of defense to be able to fight off those infections. The first line of defense really is an intact skin so your skin cells themselves form a barrier that prevents an invasion if you will from things like bacteria or fungus or viruses. If, though, those invaders would make it through your first line of defense, we actually then have a second line of defense called your immune system, and you can think of this as like your armed forces. They are there to patrol and protect and make sure that that bacteria or virus or fungus doesn't set up a site of infection.
The main army of that would be called the white blood cells, and the white blood cells go throughout the blood stream and are looking for those signs of infection. If they find infection, they can actually then release what are really like tiny weapons of destruction, and those are used to destroy the bacteria. These are things like antibodies or chemicals called cytokines.
We actually then have what I would consider a third line of defense, and that is really when you seek care through your healthcare provider. Your healthcare provider may diagnose an infection and then prescribe an appropriate antibiotic for bacterial infections or antiviruses or antifungal medicines.
Again, when we're talking about sepsis, what we're talking about then is a disorder that occurs when your body has an abnormal response to this infection. So instead of just fighting off the bacteria or the viruses or the fungus, unfortunately, your body may then start sending these chemicals that can hurt your own cells. You can think of it almost like friendly cell. So those chemicals can then turn around and damage your cells, and one of the main spots that we will see is that it can damage the cells that line the blood vessels. That can lead to problems with low pressure, and it can lead to problems with both bleeding and clotting that can occur throughout your body.
Other organs, though, can be damaged. People can have difficulty breathing because of the damage that can occur in your lungs. People can have difficulty with their kidneys or their liver as those cells become damaged. We can certainly see damage to the skin and the tissue, and unfortunately, we can also see damage that occurs throughout the entire body, leading to something that we would call multiorgan system failure, and in fact, that can lead, if it becomes progressively worse, to death of the patient.
How Do You Get Sepsis?
One of the questions that I'll often hear people ask is how does somebody get sepsis. And basically, anybody who has an infection is at risk for sepsis. We do know that there are people that are at a higher risk of sepsis than others, and those are patients who are greater than 65 years of age, and also those who are less than 10 years of age. We know that patients who have chronic diseases are at a higher risk for infection, and that can be things like chronic kidney disease or chronic liver disease, people with chronic lung disease, people who have AIDS, and people who are receiving chemotherapy for cancer.
Anytime there is a break in the lines of defense, you're at an increased risk for infection, and therefore an increased risk for sepsis so that if you have a cut or a burn in your skin, that can increase your risk that you can get an infection. Also, people who have abnormalities in their lungs can get an infection, and the most common cause for that would be smoking that impairs the ability of the tiny cells that line your lungs to sweep that infection out.
We also know that if you have any problems with your immune system, you can be at a higher risk for infection, so again, people who have cancer, that are on medicines that can suppress their immune system or certain diseases that in themselves can cause immune problems such as AIDS or HIV. The biggest risk factor, though, for sepsis is any type of infection.
What Are the Symptoms of Sepsis?
As far as diagnosing or figuring out if somebody has sepsis, there is unfortunately not one single perfect test for this. We really rely significantly on your symptoms. We actually have developed a memory device and to help patients understand those signs and symptoms of sepsis.
The first S in sepsis would be for shivering. If you're having shaking chills or fever. That certainly may indicate an infection or sepsis.
The E is for extreme pain. I'll often hear people say, "I've never felt worse in my life than at that time."
The P is for pale or discolored skin, and a lot of times, we'll hear the family members will notice that, that they feel like one of their loved ones look very different, that they seem very pale.
The next S stands for sleepiness, and again, that's something we often hear more from family members, that people don't seem to be thinking correctly, or they seem to be sleeping progressively more each day.
The I stands for I feel like I might die, or we would call that impending doom, and that is something we take very seriously when patients tell us.
And finally, the last S stands for shortness of breath. That's a very common feature in patients with sepsis to have difficulty breathing.
If you're experiencing any of these symptoms, especially in the setting of infection, you want to contact your healthcare provider immediately.
How Is Sepsis Diagnosed?
When you speak with your healthcare provider, they will likely want to talk to you and see you in the office, and they will talk to you about these symptoms that you may be having. They will then do a full examination to see if they can see any issues related to the sepsis. They'll be taking what we call vital signs, and these include your temperature, and they'll be looking to see if it's either high or low, both which can be seen with sepsis. They'll be taking your pulse which is often high in sepsis, but certain medications or conditions can make it so that you don't have an elevated pulse rate. They'll be looking at your breathing rate which may be very high with sepsis, and they'll be checking your blood pressure. That can sometimes be normal or high, but if it's low, it may be a sign that very serious sepsis is present.
They will also do a whole body exam looking for where that infection may be located. In addition, your healthcare provider may want to order specific laboratory tests. We can measure that level of your white blood cell count to see if perhaps an infection is present or if your body is reacting to that. They may also look at tests that evaluate your kidney, your liver, and even your heart.
There is a special test that we will measure called a lactate, and this measures a specific type of acid that can be elevated, especially seen during times of sepsis. In addition, they may want to obtain cultures from blood and from skin, from your sputum or from your urine that may indicate where the infection is located.
Finally, they may need to do special x-ray such as a chest x-ray or even a CAT scan (CT scan), again, to help find out where that source of infection lies.
How Is Sepsis Treated?
When we start talking about treating sepsis, one of the biggest things we want to emphasize is that the treatment for sepsis really does occur in the hospital. We know that many disorders and diseases can now be treated as an outpatient, and certainly, certain types of infection can be, but if someone truly has sepsis, that does need to be treated within the hospital itself.
One of the first things that will happen when you come in the hospital is that they will administer antibiotics for a suspected bacterial infection. In addition, we may want to also administer specific antiviral medications or antifungal medications if either of those are specific. Those are typically given through an IV initially, and then eventually, when things start getting better, changed over to an oral table. The duration of therapy may be anywhere from three days to as long as six weeks-worth of therapy, and it is very important that you finish that entire course as prescribed.
Other specific treatments for sepsis may include IV fluids. People will often get IV fluids when they come in the hospital, but during treatment for sepsis, these become especially important to keep your blood pressure. Patients will often receive several bags of IV fluids even during their very first day or first hours in the hospital.
Sometimes, surgery may be needed to treat the infection, particularly if it's an infected appendix or infected gallbladder. Those may need to be removed. Sometimes skin or tissue underneath may actually need to be cleaned out or removed if the infection starts there.
In extreme cases, patients may need to be transferred to the Intensive Care Unit where they can receive help with their breathing by a ventilator machine or perhaps help with their kidneys through something called dialysis. There are specific medications that can only be given in the Intensive Care Unit to raise the blood pressure if, when you come in, your blood pressure is quite low.
In addition to this medical therapy, there are additional resources that are often needed. Many people will need supportive care with things such as occupation or physical therapy. They may need nutritional counseling, and certainly may need social service consultation to help with support after discharge. We'll often find that patients will benefit from psychological consultation as the treatment for sepsis and the time in the hospital can often be a very stressful experience for many patients.
Life After Sepsis
One of the other questions that we'll frequently hear from patients is, "What can I expect after I leave the hospital?" Or, "What is life like after sepsis?" We do know that many sepsis survivors recover completely, but many will also have some lasting side effects. Some people will experience significant issues, and this may take weeks or even months to improve, and some problems, unfortunately, could be permanent.
We do know up to 50% of sepsis survivors may have a form of post-traumatic stress disorder, something specifically called post-sepsis survivor syndrome. Those symptoms that they may experience could include insomnia or extreme fatigue. Patient may notice they actually have hallucinations or very vivid memories of the time they spent in the hospital. People may find that they have difficulty concentrating, and they may have loss of self-esteem. In addition, they could have joint and muscle pain because of the issues with the sepsis itself. Patients have described problems with vivid nightmares or with panic attacks. Many people will often describe issues with decreased mental functioning that could be seen with just simple everyday tasks such as balancing checkbooks, and they certainly may develop a loss of self-belief.
In addition, because of the complications related to the sepsis, patients may still be dealing with issues related to organ damage. They could have skin or tissue damage or just recovering from the surgery, from the treatment of sepsis itself.
We definitely want to make sure that every patient has very close followup with a primary care provider upon discharge. Some of this, just to discuss these problems they may be experiencing, but one of the other important things is so that your physician or other healthcare provider can continue to monitor for any signs of recurrent infection. We do know that up to 10 to 20% of patients may have to go back in the hospital within the first 30 days either because of a recurrent infection or because of issues related to the post sepsis syndrome.
How To Prevent Sepsis
One of the final things we want to discuss is what can we all do to try to prevent infection and therefore decrease our risk of sepsis. The WHO or the World Health Organization reports that the number one thing that you can do to prevent infection is to wash your hands on a frequent basis. Other things would include careful care of any open areas on your skin. Make sure you clean it with soap and water, place a bandage on it, and check it daily, and contact your healthcare provider if you notice any drainage, or if you notice any significant redness surrounding the area.
One of the other important things that we always counsel patients about is to not visit the hospital if you're feeling sick or ill. We certainly don't want that type of infection to come into the hospital and cause problems with your family or loved ones.
If you do have chronic lung problems and are concerned, you can certainly wear a mask going out, or if you have an underlying lung infection, you can wear a mask also.
One of the biggest things that we want to emphasize though is to call or visit your healthcare provider if you have an infection and if you have those signs or symptoms of sepsis that we've discussed.
Again, a memory device that we use is the word sepsis itself. The first S would stand for shivering or shaking if you have chills or a fever. The E stands for extreme pain. Many patients will complain, "It was the worst I ever felt." The P stands for pale or discolored skin, something often noticed by family members. The next S would be for sleepiness or confusion, again, often noticed by loved ones. I would be for "I feel like I might die." Or the sensation of impending doom, something that, as healthcare providers, we take very seriously when patients tell us. And the final S, then, stands for shortness of breath, a symptom very common in patients with an infection.
If you're experiencing any of these symptoms, particularly in the setting of an infection, please do not hesitate to contact your healthcare provider.
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